Wrist Pain Anatomy, Causes, Symptoms, Diagnosis and Treatment
What is wrist pain?
The wrist is the complex joint between the forearm and hand. Wrist pain is not only a common symptom but it can occur for a number of reasons. It can occur suddenly (acute wrist pain), as due to a simple injury or a fracture, or it may come on insidiously and be present for a longer time (chronic wrist pain), as in arthritis, ganglion, or repetitive stress or overuse, including carpal tunnel syndrome. The wrist joint is made up of a number of bones, ligaments, and muscles. There are also three important nerves that cross the wrist from the forearm to the hand. Pain may emanate from any disease or damage of these structures.
There are eight bones that make up the wrist known as the carpus or carpal bones. These eight carpal bones are arranged in two rows – proximal and distal.
Proximal row lying next to the forearm bones :
Distal row lying next to the hand bones :
The bones of the wrist joint are connected to one another by a number of ligaments, of which the radial or lateral collateral ligament and the ulnar or medial collateral ligament are the two largest ones. The flexor retinaculum is the continuation of the deep fascia of the forearm which attaches to the carpal bones. The space thus formed between the carpal bones and the flexor retinaculum is known as the carpal tunnel. Various tendons run through the carpal tunnel. The most important structure within the carpal tunnel is the median nerve, which when compressed produces symptoms of carpal tunnel syndrome.
The wrist joint is made up of several joints.
- Radiocarpal joint – the 2 long bones of the forearm are the radius and ulna. The radius lies towards the thumb and the ulna towards the little finger. At the distal end (the part farthest away from the body), the articular disc binds the radius to the ulna and carpal bones, and separates the distal ulna from the carpal bones. The proximal carpal bones and the distal end of the radius form the radiocarpal joint.
- Intercarpal joints – thesel joints are formed between the proximal and distal rows of carpal bones.
- Carpometacarpal joints – the distal row of the carpal bones with the proximal portion of the metacarpal bones of the hand form the carpometacarpal joints.
The muscles acting on the wrist joint are situated in the forearm and end in tendons which cross the joint and end on the hand. The muscles allow a range of movements such as flexion, extension, abduction or radial deviation, and adduction or ulnar deviation.
Nerves and Blood Vessels
The three important nerves that cross the wrist from the forearm to supply the hand are the radial, median, and ulnar nerve.
- The radial nerve supplies the back of the hand from the thumb to the middle finger.
- The median nerve supplies the thumb, index, and middle finger and the inner half of the ring finger.
- The ulnar nerve supplies little finger and the outer half of the ring finger.
Blood supply is through the radial and ulnar arteries.
Wrist Pain Symptoms
The symptoms often point to the cause of wrist pain. Wrist pain may be of varying intensity and can be dull, sharp, stabbing, aching, or burning.
It is usually unilateral (in one wrist) but may be bilateral (in both wrists). There may be tenderness meaning pain when the wrist is touched. Wrist pain can only be present or worsen with pain although in some cases it is present even at rest. Other symptoms that may accompany wrist pain includes :
- Tingling or numbness.
- Signs of injury such as bruises.
- Muscle weakness.
- Reduced mobility of the joint.
- Obvious deformity of the wrist.
- Redness, warmth, or swelling over the wrist.
- Pain in the shoulder, arm, hand, or fingers.
Causes of Wrist Pain
Wrist pain may be caused by a variety of problems, usually arising due to damage to the structures that comprise the wrist joint. The common causes of wrist pain are :
- Injury – bruising and swelling are common signs of injury. Injury may also result in fracture, the most common fracture of the wrist being Colles’ fracture or distal radius fracture, which usually occurs due to falling on an outstretched hand. It commonly occurs in elderly people but is also seen in sportsmen, skiers and bikers. Besides bruising and swelling, there will be pain, tenderness, and deformity of the wrist.
- Inflammatory causes such as tendonitis and bursitis.
- Rheumatoid arthritis is an autoimmune disease, where the body’s immune system attacks its own healthy tissues. It results in inflammation of the joints and surrounding tissues. Rheumatoid arthritis of the wrist is common. One or both wrists may be affected. Middle-aged women are more likely to be affected. Morning stiffness, joint pain, and deformity are common symptoms.
- Osteoarthritis may affect the wrist but is less common. It is likely to occur with age and may cause pain, swelling, and stiffness of the joint.
- Carpal tunnel syndrome – symptoms develop due to compression of the median nerve as it passes through the carpal tunnel. Along with wrist pain, there may be symptoms of tingling, numbness, and pain in the areas supplied by the median nerve, as well as muscle wasting and weakness in the hands. Repetitive movements of the wrist is the most common cause, such as typing on a computer keyboard, sewing, using a vibrating tool, or playing handball. Pregnancy, hypothyroidism, diabetes, obesity, and rheumatoid arthritis are some of the risk factors for its development.
- Repetitive stress or overuse may also result in wrist pain, without carpal tunnel syndrome.
- Ganglion cyst is a swelling that may form around the wrist joint. Although usually painless, there may be slight discomfort and pain.
- Infection of the wrist which is more likely to arise when microbes enter through a break in the skin or a piercing injury. Less likely it may arise from microbes reaching the wrist through the bloodstream.
Other less common causes of wrist pain are :
- Dupuytren’s contracture.
- Trigger finger or trigger thumb.
- Kienbock’s disease.
Diagnosis of Wrist Pain
Initial diagnosis will be based on history and physical examination. Subsequently other tests may be necessary such as :
- CT scan
- Bone scan
- Nerve function tests
Treatment of Wrist Pain
Treatment will depend upon the cause of wrist pain, keeping in mind the age and general health of the patient.
- Rest to the joint.
- Cold compress, ice, and elastic bandage may give relief in minor injuries.
- Wrist support with wrist braces.
- Medication for pain relief and treatment of underlying condition.
- Cortisone injections for inflammation may be given in some cases.
- Surgery for fracture, carpal tunnel syndrome, tendon or ligament repair.
- Arthroscopic wrist surgery may be done for treatment of ligament injuries, ganglion cysts, and some specific types of wrist fractures.